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Higher NAD+ activates the sirtuin family of NAD+-dependent deacetylases, particularly SIRT1, which deacetylates PGC-1alpha (promoting mitochondrial biogenesis), FOXO transcription factors (enhancing stress resistance), and NF-kappaB (reducing inflammation)

For this reason, patients are advised to inform their healthcare provider of all medications, supplements, or herbs they are taking before starting NAD+ injections, even though no incompatibilities are documented thus far

A recent study investigated whether or not this causes iodine deficiency (which is also a concern with a vegan diet)